Provider Demographics
NPI:1487195582
Name:MIDWESTERN PSYCHOLOGICAL CONSULTANTS, LTD
Entity Type:Organization
Organization Name:MIDWESTERN PSYCHOLOGICAL CONSULTANTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, ABPP
Authorized Official - Phone:618-979-5087
Mailing Address - Street 1:6201 W MAIN ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-6870
Mailing Address - Country:US
Mailing Address - Phone:618-979-5087
Mailing Address - Fax:618-504-1160
Practice Address - Street 1:6201 W MAIN ST
Practice Address - Street 2:SUITE 130
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-6870
Practice Address - Country:US
Practice Address - Phone:618-979-5087
Practice Address - Fax:618-504-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006112103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty